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Open Access 01-12-2018 | Research article

Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study

Authors: Halldora Ögmundsdottir Michelsen, Marie Nilsson, Fredrik Scherstén, Ingela Sjölin, Alexandru Schiopu, Margret Leosdottir

Published in: BMC Cardiovascular Disorders | Issue 1/2018

Abstract

Background

Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes.

Method

This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year.

Results

Patients in the tailored group achieved better control of total cholesterol (− 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12–14-month follow-up, (p = 0.01), LDL cholesterol (− 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (− 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1–1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02).

Conclusion

A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.

Piepoli MF, Corra U, Dendale P, Frederix I, Prescott E, Schmid JP, et al. Challenges in secondary prevention after acute myocardial infarction: a call for action. Eur J Prev Cardiol. 2016;23(18):1994–2006.CrossRefPubMed

Jernberg T, Hasvold P, Henriksson M, Hjelm H, Thuresson M, Janzon M. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36(19):1163–70.CrossRefPubMed

Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation. 2010;121(6):750–8.CrossRefPubMed

Kotseva K, Wood D, De Bacquer D, De Backer G, Ryden L, Jennings C, et al. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016;23(6):636–48.CrossRefPubMed

Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.CrossRefPubMed

Wilson K, Gibson N, Willan A, Cook D. Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med. 2000;160(7):939–44.CrossRefPubMed

Rauch B, Davos CH, Doherty P, Saure D, Metzendorf MI, Salzwedel A, et al. The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy: a systematic review and meta-analysis of randomized and non-randomized studies - the cardiac rehabilitation outcome study (CROS). Eur J Prev Cardiol. 2016;23(18):1914–39.CrossRefPubMedPubMedCentral

Jorstad HT, Alings AM, Liem AH, von Birgelen C, Tijssen JG, de Vries CJ, et al. RESPONSE study: randomised evaluation of secondary prevention by outpatient nurse SpEcialists: study design, objectives and expected results. Neth Heart J. 2009;17(9):322–8.CrossRefPubMedPubMedCentral

Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet. 2008;371(9629):1999–2012.CrossRefPubMed

10.

Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016;23(11):NP1–NP96.

11.

Piepoli MF, Corra U, Adamopoulos S, Benzer W, Bjarnason-Wehrens B, Cupples M, et al. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Eur J Prev Cardiol. 2014;21(6):664–81.CrossRefPubMed

12.

Giannuzzi P, Temporelli PL, Marchioli R, Maggioni AP, Balestroni G, Ceci V, et al. Global secondary prevention strategies to limit event recurrence after myocardial infarction: results of the GOSPEL study, a multicenter, randomized controlled trial from the Italian cardiac rehabilitation network. Arch Intern Med. 2008;168(20):2194–204.CrossRefPubMed

13.

McAlister FA, Lawson FM, Teo KK, Armstrong PW. Randomised trials of secondary prevention programmes in coronary heart disease: systematic review. BMJ. 2001;323(7319):957–62.CrossRefPubMedPubMedCentral

14.

Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2016;1:CD001800.

15.

Hagström E, Nilsson L, Hambreus K. Swedeheart Annual report. Huddinge, 141 86 Stockholm: Karolinska University Hospital 2015. Report No.: ISSN: 2000–1843.

16.

RIKS-HIA. 2016. [Available from: http://www.ucr.uu.se/swedeheart/start-riks-hia].

17.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur J Prev Cardiol. 2012;19(4):585–667.

18.

Nordic Council of Ministers. Nordic Nutrition Recommendations 2012: Integrating nutrition and physical activity. 5 ed. Copenhagen: Nordisk Ministerråd; 2014. p. 627.

19.

Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92–8.PubMed

20.

Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.CrossRefPubMedPubMedCentral

21.

Cholesterol Treatment Trialists Collaboration, Fulcher J, O'Connell R, Voysey M, Emberson J, Blackwell L, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015;385(9976):1397–405.

22.

Giannuzzi P, Temporelli PL, Maggioni AP, Ceci V, Chieffo C, Gattone M, et al. GlObal secondary prevention strategiEs to limit event recurrence after myocardial infarction: the GOSPEL study. A trial from the Italian cardiac rehabilitation network: rationale and design. Eur J Cardiovasc Prev Rehabil. 2005;12(6):555–61.CrossRefPubMed

23.

Giannuzzi P, Saner H, Bjornstad H, Fioretti P, Mendes M, Cohen-Solal A, et al. Secondary prevention through cardiac rehabilitation: position paper of the working group on cardiac rehabilitation and exercise physiology of the European Society of Cardiology. Eur Heart J. 2003;24(13):1273–8.CrossRefPubMed

24.

Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U, et al. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37.CrossRefPubMed

25.

Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U, et al. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet. 2009;373(9667):929–40.CrossRefPubMed

26.

Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart. 2005;91(1):10–4.CrossRefPubMedPubMedCentral

27.

Campbell NC. Secondary prevention clinics: improving quality of life and outcome. Heart. 2004;90(Suppl 4):iv29–32. discussion iv9–40PubMedPubMedCentral

28.

Campbell NC, Ritchie LD, Thain J, Deans HG, Rawles JM, Squair JL. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart. 1998;80(5):447–52.CrossRefPubMedPubMedCentral

29.

Kotseva K, De Bacquer D, De Backer G, Ryden L, Jennings C, Gyberg V, et al. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on secondary and primary prevention by intervention to reduce events (EUROASPIRE) IV cross-sectional survey in 14 European regions. Eur J Prev Cardiol. 2016;23(18):2007–18.CrossRefPubMed

30.

Dallongeville J, Banegas JR, Tubach F, Guallar E, Borghi C, De Backer G, et al. Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study. Eur J Prev Cardiol. 2012;19(3):541–50.CrossRefPubMed

31.

Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB. Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Circulation. 2007;116(15):1653–62.CrossRefPubMed

32.

Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Allison TG, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004;44(5):988–96.CrossRefPubMed

33.

Sanghavi M, Gulati M. Sex differences in the pathophysiology, treatment, and outcomes in IHD. Curr Atheroscler Rep. 2015;17(6):511.CrossRefPubMed

34.

Bäck M, Ekström M, Hagström E, Leosdottir M. Swedeheart Annual report 2017. Huddinge, 141 86 Stockholm: Karolinska University Hospital 2018. Report No.: ISSN: 2000-1843.

35.

Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014;12:CD011273.

36.

Grazzi G, Mazzoni G, Myers J, Codeca L, Pasanisi G, Napoli N, et al. Improved walking speed is associated with lower hospitalisation rates in patients in an exercise-based secondary prevention programme. Heart. 2016;102(23):1902–8.CrossRefPubMed

37.

Kavanagh T, Hamm LF, Beyene J, Mertens DJ, Kennedy J, Campbell R, et al. Usefulness of improvement in walking distance versus peak oxygen uptake in predicting prognosis after myocardial infarction and/or coronary artery bypass grafting in men. Am J Cardiol. 2008;101(10):1423–7.CrossRefPubMed

Title: Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study
Authors: Halldora Ögmundsdottir Michelsen
Marie Nilsson
Fredrik Scherstén
Ingela Sjölin
Alexandru Schiopu
Margret Leosdottir
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2018
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-018-0907-0

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Results

Conclusion

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